Information de reference pour ce titreAccession Number: | 01337498-201111000-00013.
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Author: | Kajander, Sami A. MD; Joutsiniemi, Esa MD; Saraste, Markku MD; Pietila, Mikko MD, PhD; Ukkonen, Heikki MD, PhD; Saraste, Antti MD, PhD; Sipila, Hannu T. PhD; Teras, Mika PhD; Maki, Maija MD, PhD; Airaksinen, Juhani MD, PhD; Hartiala, Jaakko MD, PhD; Knuuti, Juhani MD, PhD
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Institution: | From the Turku PET Centre (S.K., H.T.S., M.T., J.K.), Department of Medicine (E.J., M.P., H.U., A.S., J.A.), and Department of Clinical Physiology and Nuclear Medicine (M.S., M.M., J.H.), University of Turku, Turku, Finland.
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Title: | |
Source: | Circulation: Cardiovascular Imaging. 4(6):678-684, November 2011.
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Abstract: | Background-: The standard interpretation of perfusion imaging is based on the assessment of relative perfusion distribution. The limitations of that approach have been recognized in patients with multivessel disease and endothelial dysfunction. To date, however, no large clinical studies have investigated the value of measuring quantitative blood flow and compared that with relative uptake.
Methods and Results-: One hundred four patients with moderate (30%-70%) pretest likelihood of coronary artery disease (CAD) underwent PET imaging during adenosine stress using 15O-water and dynamic imaging. Absolute myocardial blood flow was calculated from which both standard relative myocardial perfusion images and images scaled to a known absolute scale were produced. The patients and the regions then were classified as normal or abnormal and compared against the reference of conventional angiography with fractional flow reserve. In patient-based analysis, the positive predictive value, negative predictive value, and accuracy of absolute perfusion in the detection of any obstructive CAD were 86%, 97%, and 92%, respectively, with absolute quantification. The corresponding values with relative analysis were 61%, 83%, and 73%, respectively. In region-based analysis, the receiver operating characteristic curves confirmed that the absolute quantification was superior to relative assessment. In particular, the specificity and positive predictive value were low using just relative differences in flow. Only 9 of 24 patients with 3-vessel disease were correctly assessed using relative analysis.
Conclusions-: The measurement of myocardial blood flow in absolute terms has a significant impact on the interpretation of myocardial perfusion. As expected, multivessel disease is more accurately detected.
Clinical Trial Registration-: URL: http://www.clinicaltrials.gov- ouverture dans une nouvelle fenêtre. Unique identifier: NCT00627172.
(C) 2011 American Heart Association, Inc.
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Author Keywords: | cardiac-gated imaging techniques; positron-emission tomography; coronary artery disease; perfusion.
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References: | 1. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, O'Gara PT, Carabello BA, Russell RO Jr, Cerqueira MD, St John Sutton MG, DeMaria AN, Udelson JE, Kennedy JW, Verani MS, Williams KA, Antman EM, Smith SC Jr, Alpert JS, Gregoratos G, Anderson JL, Hiratzka LF, Faxon DP, Hunt SA, Fuster V, Jacobs AK, Gibbons RJ, Russell RO; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American Society for Nuclear Cardiology. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). Circulation. 2003;108:1404-1418.
2. Hara T, Michihata T, Yokoi F, Sakamoto S, Masuoka T, Iio M. Quantitative measurement of disease by intravenous injection of 13N-ammonia in positron emission tomography. Eur J Nucl Med. 1990;16:231-235.
3. Muzik O, Duvernoy C, Beanlands RS, Sawada S, Dayanikli F, Wolfe ER Jr, Schwaiger M. Assessment of diagnostic performance of quantitative flow measurements in normal subjects and patients with angiographically documented coronary artery disease by means of nitrogen-13 ammonia and positron emission tomography. J Am Coll Cardiol. 1998;31:534-540.
4. Yoshinaga K, Katoh C, Noriyasu K, Iwado Y, Furuyama H, Ito Y, Kuge Y, Kohya T, Kitabatake A, Tamaki N. Reduction of coronary flow reserve in areas with and without ischemia on stress perfusion imaging in patients with coronary artery disease: a study using oxygen 15-labeled water PET. J Nucl Cardiol. 2003;10:275-283.
5. Parkash R, deKemp RA, Ruddy TD, Kitsikis A, Hart R, Beauchesne L, Williams K, Davies RA, Labinaz M, Beanlands RS. Potential utility of rubidium 82 PET quantification in patients with 3-vessel coronary artery disease. J Nucl Cardiol. 2004;11:440-449.
6. Kajander S, Ukkonen H, Sipila H, Teras M, Knuuti J. Low radiation dose imaging of myocardial perfusion and coronary angiography with a hybrid PET/CT scanner. Clin Physiol Funct Imaging. 2009;29:81-88.
7. Pandit-Taskar N, Grewal RK, Strauss HW. Cardiovascular system. In: Christian PE, Waterstram-Rich KM, eds. Nuclear Medicine and PET/CT Technology and Techniques. St Louis, MO: Mosby Elsevier; 2007:479-512.
8. Bol A, Melin JA, Vanoverschelde JL, Baudhuin T, Vogelaers D, De pauw M, Michel C, Luxen A, Labar D, Cogneau M. Direct comparison of [13N]ammonia and [15O]water estimates of perfusion with quantification of regional myocardial blood flow by microspheres. Circulation. 1993;87:512-525.
9. El Fakhri G, Kardan A, Sitek A, Dorbala S, Abi-Hatem N, Lahoud Y, Fischman A, Coughlan M, Yasuda T, Di Carli MF. Reproducibility and accuracy of quantitative myocardial blood flow assessment with (82)Rb PET: comparison with (13)N-ammonia PET. J Nucl Med. 2009;50:1062-1071.
10. Dayanikli F, Grambow D, Muzik O, Mosca L, Rubenfire M, Schwaiger M. Early detection of abnormal coronary flow reserve in asymptomatic men at high risk for coronary artery disease using positron emission tomography. Circulation. 1994;90:808-817.
11. Pitkanen OP, Nuutila P, Raitakari OT, Porkka K, Iida H, Nuotio I, Ronnemaa T, Viikari J, Taskinen MR, Ehnholm C, Knuuti J. Coronary flow reserve in young men with familial combined hyperlipidemia. Circulation. 1999;99:1678-1684.
12. Kaufmann PA, Camici PG. Myocardial blood flow measurement by PET: technical aspects and clinical applications. J Nucl Med. 2005;46:75-88.
13. El Fakhri G, Sitek A, Di Carli MF. QDA: an automated graphical software for absolute quantification of regional myocardial blood flow [abstract]. J Nucl Med. 2007;48:203.
14. Nesterov SV, Han C, Maki M, Kajander S, Naum AG, Helenius H, Lisinen I, Ukkonen H, Pietila M, Joutsiniemi E, Knuuti J. Myocardial perfusion quantitation with 15O-labelled water PET: high reproducibility of the new cardiac analysis software (Carimas) [published correction appears in Eur J Nucl Med Mol Imaging. 2010;37:832]. Eur J Nucl Med Mol Imaging. 2009;36:1594-1602.
15. Fricke H, Elsner A, Weise R, Bolte M, van den Hoff J, Burchert W, Domik G, Fricke E. Quantitative myocardial perfusion PET combined with coronary anatomy derived from CT angiography: validation of a new fusion and visualization software. Z Med Phys. 2009;19:182-188.
16. Hajjiri MM, Leavitt MB, Zheng H, Spooner AE, Fischman AJ, Gewirtz H. Comparison of positron emission tomography measurement of adenosine-stimulated absolute myocardial blood flow versus relative myocardial tracer content for physiological assessment of coronary artery stenosis severity and location. J Am Coll Cardiol Cardiovasc Imaging. 2009;2:751-758.
17. Kajander S, Joutsiniemi E, Saraste M, Pietila M, Ukkonen H, Saraste A, Sipila HT, Teras M, Maki M, Airaksinen J, Hartiala J, Knuuti J. Cardiac PET/CT imaging accurately detects anatomically and functionally significant coronary artery disease. Circulation. 2010;122:603-613.
18. Berger A, Botman KJ, MacCarthy PA, Wijns W, Bartunek J, Heyndrickx GR, Pijls NH, De Bruyne B. Long-term clinical outcome after fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease. J Am Coll Cardiol. 2005;46:438-442.
19. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van't Veer M, Klauss V, Manoharan G, Engstrom T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF; FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213-224.
20. Pijls NH. Optimum guidance of complex PCI by coronary pressure measurement. Heart. 2004;90:1085-1093.
21. Nekolla SG, Reder S, Saraste A, Higuchi T, Dzewas G, Preissel A, Huisman M, Poethko T, Schuster T, Yu M, Robinson S, Casebier D, Henke J, Wester HJ, Schwaiger M. Evaluation of the novel myocardial perfusion positron-emission tomography tracer 18F-BMS-747158-02: comparison to 13N-ammonia and validation with microspheres in a pig model. Circulation. 2009;119:2333-2342.
22. Knuuti J, Kajander S, Maki M, Ukkonen H. Quantification of myocardial blood flow will reform the detection of CAD. J Nucl Cardiol. 2009;16:497-506.
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Language: | English.
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Document Type: | Original Articles.
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Journal Subset: | Clinical Medicine.
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ISSN: | 1941-9651
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DOI Number: | https://dx.doi.org/10.1161/CIRCI...- ouverture dans une nouvelle fenêtre
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